Care Home: Hulse Avenue

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What the care home does well The AQAA states `we have very good knowledge of the diverse needs of our service users and we deliver a high standard of care and quality services. The staff team are established, experienced, diverse and well trained, and this ensures that our high standards are maintained`. All of the people that we spoke to stated that they were very happy with Hulse Avenue and everyone who completed surveys made very positive comments. Staff said that they felt well supported by the organisation and the management. Relatives` comments were very positive, `this is the best home they have lived in`, `my prayers were answered when they moved into Hulse Avenue, I am very happy with the care`. Some of the service users were able to express that they liked living at the home and others were observed to be happy and laughing with the staff. The care plans with the involvement and the view of the service users are well written and person centred and they show that people are involved in making decisions about their care and their lives in the home. The ethos of Hulse Avenue is that it is the home of the service users and the staff are there to support them to live their lives as they wish and to make their own decisions about every aspect of their lives in the home and this was evidenced during the inspection. Service users are encouraged and supported to develop their skills within the home and to participate in their choice of activities within the home and the wider community. Staff have a wide range of training and development opportunities including effective induction and other core skills training when first recruited. All staff receive regular supervision and both staff and service users` meetings are held on a regular basis. this ensures that everybody at Hulse Avenue are listened to and their views are taken into account in the running of the home. The organisation has recognised the dedication of the staff team at Hulse Avenue and have awarded them a `staff recognition award` for their support with one service user regarding their transition to the home and to another service user who underwent surgery. What has improved since the last inspection? There were no requirements or recommendations set at the last inspection, however Hulse Avenue has continued to improve the service. During the last twelve months there has been an improvement in service user participation in activities within the home and in the community. Staffing levels have been increased and more information has been produced in a pictorial format due to the changing needs of the service users. The environment has been improved with the refurbishment of the dining room and all service users have been provided with individual lockable medicine cabinets. What the care home could do better: There are no requirements or recommendations set at this inspection, however the manager has shown through the AQAA and discussion during the inspection that she has identified areas that could be improved. These areas include the purchase of two power packs for two of the service users` wheelchairs, this will support them in improving access to the community. Also to look at improving everyday skills teaching for service users and for this to be more structured and goals more easily identified. Key inspection report Care homes for adults (18-65 years) Name: Address: Hulse Avenue 1a Hulse Avenue Collier Row Romford Essex RM7 8NT     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Julie Legg     Date: 0 8 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Hulse Avenue 1a Hulse Avenue Collier Row Romford Essex RM7 8NT 01708735944 01708735944 natashaf@outlookcare.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Outlook Care care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning Disability Code LD Date of last inspection Brief description of the care home 1a Hulse Avenue provides accommodation and support for five people who have learning disabilities, some of whom also have a physical disability. Opened in 1992, it is run by Outlook Care Ltd, an organisation that specialise in providing housing and support services for vulnerable adults in North East London and Essex. It is a purpose built bungalow on a generous corner plot with a good-sized front parking forecourt. All residents have their own bedroom, some of which are equipped to help with physical disability. The layout of this excellent building is helpful for residents that use wheelchairs - including wide corridors; special bath and shower facilities; and large communal rooms. There is also a large garden, with a patio and fishpond. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 5 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star.This means the people who use this service experience excellent outcomes. This was an unannounced key inspection which took place over one day. We spoke to the manager and two support workers. Five staff and five service user surveys were completed and returned and we telephoned relatives. Staff were asked about the care practices that service users received and what it was like to work at Hulse Avenue. We were able to speak to some of the service users regarding their views on living at the home and we were able to observe the rapport between service users and staff. All of the feedback regarding Hulse Avenue was very positive. A tour of the home was undertaken, including the bedrooms, bathrooms, kitchen and living areas. The home is well maintained and decorated and furnished in a homely fashion and meets the needs of the service users who live there. Care Homes for Adults (18-65 years) Page 5 of 30 We looked at staff and service users files as well as other records and documentation. The manager completed an Annual Quality Assurance Assessment (AQAA) prior to the inspection and evidence from this has also been included in this report. We would like to thank the service users, staff and relatives for their input during this inspection. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: There are no requirements or recommendations set at this inspection, however the manager has shown through the AQAA and discussion during the inspection that she Care Homes for Adults (18-65 years) Page 7 of 30 has identified areas that could be improved. These areas include the purchase of two power packs for two of the service users wheelchairs, this will support them in improving access to the community. Also to look at improving everyday skills teaching for service users and for this to be more structured and goals more easily identified. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service undertakes a comprehensive pre admission assessment and a flexible transition period also takes place. This ensures that the service can meet the service users needs and that all prospective service users have sufficient information regarding the facilicities and services that can be provided. Evidence: The home has developed a comprehensive statement of purpose and service users guide, which are very specific to the service user group they care for. It clearly sets out the objectives and philosophy of the service. Service users know what to expect when they move into the home and gives a clear account of the service provided, quality of the accommodation and how to make a complaint. The statement of purpose and service user guide are provided in formats that meets the needs of the service users. In the past twelve months there has been one new admission to the home. This service user had lived for many years in a home out of the borough and moved to be nearer to their family. The management and staff were very aware of the life changing Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: decision that the prospective service user and their family were making and they were given information, reassurance and support. The pre admission assessment was looked at, it was evident that a significant amount of time and effort had been spent in planning to make the admission a positive experience. The service had completed a comprehensive and in depth pre admission assessment, gathering information from the previous service, relevant professionals and family. The assessment was personalised and included information on the life history and likes and dislikes of the service user. The assessment focused on achieving positive outcomes for the service user and this included ensuring that the facilities, staffing and specialist services provided by the home met their diverse needs. The service user was able to spend time at the home over a number of visits including overnight stays, accompanied by staff who knew him and staff from Hulse Avenue were able to visit the service user at his previous home. After admission weekly progress sheets were completed which showed how the service user was settling and improvements in their well being were noted during this transition period. The admission of the service user has been very successful with an improvement in his physical well being. They are interacting positively with the other service users and staff. On the day of the inspection they were seen playing and smiling at the staff. It was very evident that the service is providing excellent person centred care. As stated earlier the service user and their family undertook a number of visits to the service prior to their admission. The service users family and the relevant professionals were very happy with the way the transition took place. Relatives spoke highly of the transition and the placement overall, all of my prayers have been answered. We are extremely happy with Hulse Avenue. The service is commended on meeting the needs and aspirations of new service users and working in partnership with them throughout the pre admission process. Indeed Outlook Care have awarded Hulse Avenue a Staff Recognition Award for their role in the very successful transition of the new service user. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are comprehensive care plans and risk assessments in place which provide the staff the information they need require to meet the needs of the service users. Service users are involved in decisions about their lives and they play an active part in planning the care and support they receive Evidence: The service is very clear that service users are in control of their lives and that they direct the service. We spoke to staff who told us that they are committed in supporting service users to lead purposeful and fulfilling live as independently as possible. There was evidence that the staff also support service users to make their own informed decisions and to take risks in their daily lives. Service users are actively encouraged and supported to assist with the development of their own care plans. The care plans are based on a very comprehensive assessment, which include reference to equality and diversity and clearly addresses any identified Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: needs. Information was found specific to the religious, cultural and social care needs of service users and how these needs should be met. Care plans also focus on service users strengths and personal preferences and are very much seen as working documents. Other information regarding service users likes and dislikes, how they communicate and what they are able to do independently, tasks they need assistance with as well as their life history are in a pictorial format and photographs. All of this information was very detailed and individualised, which can easily be understood by staff particularly those that may not be as familiar with the individual service user. The service operates a key worker system who ensure that the care plans are being kept up to date through regular evaluation and review. The key worker also supports the service users to participate in the ongoing review process. Reviews focus on what has worked for the service user, where progress is being made, achievements, and concerns and identified action points. Relatives spoken to as part of the inspection process all confirmed that they are invited to attend the reviews. Care plans include comprehensive risk assessments which are regularly reviewed. Risk assessments identified risk areas that were pertinent to individual service users and assessments included clear guidelines for staff to follow in managing risks that were posed to the service users. It was very apparent during the inspection from observing staff interaction with the service users and from looking at documentation, that the service has a can do attitude and risks are managed positively which assist the service users to lead the life they want. Any limitations on freedom, choice or facilities are always in the persons best interests. Daily records were examined which linked to the care plans and focused on the specific needs of the service users. The notes that were written were person centred and provided specific information about the service user such as, monitoring their care needs, dietary intake, night time routines, participation in activities as well as their physical and emotional well being. An advocacy service was previously in place at the home and the manager is currently negotiating for this to recommence. The manager feels that the service users would benefit from this service to ensure that they can express their views and wishes to an external person who can work with them. The service works creatively with other services and organisations such as health and social care professionals to ensure that the service users whole life needs are met and goals addressed. The service recognises its own limitations and when to seek support from others to meet the individual needs of the service users. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Service users are consulted on how the service runs and are able to influence key decisions in the home whatever their communication style. They are involved in the day-to-day life of the home and the manager is looking to support service users to be involved with staff recruitment. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are able to make choices about their life style and are supported to develop their life skills in all areas including, social, cultural and recreational activities. Evidence: Central to the homes aims and objectives is the promotion of the individuals right to live an ordinary and meaningful life in the home and in the community. Service users are encouraged and supported to enjoy all of the rights and responsibilities of citizenship. Central to the care and support provided is the importance of respect fro the human rights of people in the areas of fairness, equality, dignity, respect and autonomy. Service users have as number of regular forums where they can voice their views. These include monthly house meetings and service user forums that are organised by Outlook Care. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: Service users are encouraged and supported to enjoy a full and stimulating lifestyle with a variety of options to choose from. There are many activities both within the home and in the community such as, ten pin bowling, art club, theatre, local cafes and Romford greyhound racing. Service users are supported to shop for their own personal toiletries and clothes and one service user is supported to attend church. The home is part of an organisation and service users also attend functions at other Outlook Care homes.There are games, DVDs and recently the home have bought some musical instruments which include a full drum kit. One service users stated in their survey I like playing the drums and watching scarey films. Some of the service users are supported to assist in the garden, where there is a herb bed and a vegetable patch is planned for this summer. All of the service users are going on holiday this year. During the inspection service users were observed interacting with staff, one was playing ball, another was watching the television. Though their communication skills were limited they were laughing and had a good rapport with the staff. Two of the service users were out bowling and on returning were animated and telling the staff what had happened. There is a range of activities that service users could participate in and they had the freedom and choice to wander around the home as they liked. The service seeks the views of the service users and considers their varied interests when planning the routines of daily living. Routines are very flexible and service users are encouraged to make choices in their lives. One service user was still in bed during the inspection, this was their choice. The service actively encourages and provides opportunities for service users to develop and maintain social and independent living skills were appropriate. this includes developing and maintaining family and personal relationships. All of the service users receive visits from family and some go to their relatives home. relatives confirmed that they can visit at any time and are always made to feel welcome. Outcomes for service users living at Hulse Avenue are positive and there is evidence that they are enjoying the life opportunities that they experience. Service users are encouraged to be involved in area of daily living within the home and staff support service users to assist with the preparation of snacks and meals and shopping. The service provides meals,which are varied and nutritionally balanced and meets the dietary needs of the service users. Meals and snacks are offered flexibly to suit individual lifestyles and in an area of the home where they wish to eat. Staff support service users to choose their meals from an extensive range of pictures when devising the weekly menu. Though the manager stated that service users can have a different meal to their choice if they so wish. Cultural and health care needs as well as service Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: user choice are considered when planning meals. Service users have differing needs such as pureed meals, thickened fluids and meals that are presented in small pieces. There was plenty of fresh fruit and vegetables, and fridges and freezers were well stocked with a variety of food. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that service users receive is base on their individual needs and on the principles of dignity, respect and privacy. Evidence: The support around personal and health care is very person centred with support based upon the rights of dignity, equality, fairness, autonomy and respect. All of the service users have individual health plans which identify their personal and health care needs and also detail how these will be delivered. Staff are highly aware that the way in which support is given is a key issue for younger adults. All support is flexible, consistent and able to meet the changing needs of the service users. The use of a key worker system has meant that staff have very detailed knowledge about the individual service users personal and health care needs. The plans also identified service users daily routines including the type of support they required with their personal hygiene. Staff were observed to respond appropriately and sensitively in various situations. All of the service users are registered with a GP and are supported by staff to attend Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: health care appointments such as dentist. chiropodist, optician and well women clinic. Other specialist input is received from Psychiatry and Psychology. Some of the service users receive health care input at the home such as community nurses, other specialist nurses, physiotherapists and occupational therapists. Specialist equipment are provided to encourage maximum Independence for service users, these are regularly reviewed and replaced to accommodate changing needs. There was evidence that one of the service users has been receiving specialist advice regarding their wheelchair. Staff are trained and competent in health care matters particularly in the care of service users who are now presenting with degenerative illnesses. The service has arranged training on these health care topics to ensure that they can meet the changing needs of the service users. The service has an efficient medication policy, procedure and practice guidance. Staff involved in the administration of medication have all received appropriate training and competency assessment. There are monthly medication audits which are undertaken during the Regulation 26 visits and the manager also carries out her own audits. All of the medication is kept securely locked in each service users bedroom, this is seen as good practice and person centred. Medication records were checked during this inspection and were seen to be appropriately completed. The medication file contained photographs of each service user, whether they had a known allergy and information about each medication that had been prescribed. Some of the service users take medication as and when PRN and there where individual protocols for all of these medications. All of the service users have regular medication reviews which are undertaken by the GP. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Services users are listened to and their views and concerns are taken seriously. The robust and effective safeguarding polices and procedures ensure the protection of the service users. Evidence: The ethos of the home is that it welcomes complaints and suggestions about the service and uses them positively and outcomes are used to improve the service for the benefit of service users. Surveys that were received from service user indicated that they were very happy with the service and relatives that were spoken to also stated that they were very satisfied with the service. One relative stated, If I was not happy with something then I would talk to Natasha (manager). It was apparent during the inspection that staff knew the importance of taking the views of the service users seriously and that listening and responding to issues was extremely important. Service users are given a copy of the complaints procedure in a format that is easier for them to understand. The procedure has been produced in a pictorial and DVD format. Some of the service users from Outlook Care were involved in the production of the DVD. The service has also produced pre paid complaint cards that are addressed to their head office and staff are encouraged to take them when supporting service users in the community. This means that if a member of the public was Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: concerned then they can be given a complaints card. During the inspection we looked at the complaints book and there have been none during the past twelve months neither has the Commission received any complaints. The service has a whistle blowing policy and staff know that the organisation will support them if they report poor/abusive practice. The manager is clear when an incident needs referred to the Local Authority as part of their local procedures for safeguarding. The manager has an open door policy which encourages service users and staff to discuss any concerns and she is open and transparent in discussions with external bodies. All of the staff have undertaken training in safeguarding adults and this topic is discussed during staff supervision and team meetings. Staff are vigilant and very alert to changes in service users moods and behaviours as some of the service users can self harm and the potential for a service user to abuse another. Staff are trained to respond appropriately to physical and verbal aggression and fully understand that the use of physical intervention is seen as a last resort. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables service users to be as independant as possible in a safe, well maintained and comfortable environment. Evidence: During a tour of the building it was identified that the provider and manager have ensured that the physical environment of the home provides for the individual needs of the service users who live there. The home is appropriate for the particular lifestyle and needs of the service users and is homely, clean, safe and comfortable, well maintained and reflects the individuality of the service users. The service goes that extra mile to provide an environment that fully meets the needs of all of the service users and ensures that the decoration and furnishing are always maintained to a good standard. The Annual Quality Assurance Assessment (AQAA) identified that during the past year, new garden furniture has been purchased, all communal areas have been redecorated and security in the home has been improved by the installation of door alarms. During the next twelve months the service is looking to purchase a summer house and to replace some of the flooring. The environment is fully able to meet the changing needs of the service users, The building provides a homely environment which is fully accessible throughout with wide corridors and doors, and a wide range of up to date specialist equipment and Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: adaptations meet the individual needs of the service users. The management has a proactive infection control policy and they work closely with their own staff and service users. The management encourages service users and are creative in ensuring that they are as fully involved as possible in decision making regarding the decor and any other changes in their environment. All of the bedrooms are single and of a good size, with specialist equipment where required. Service users have been able to personalise their rooms which reflect their personalities and interests. Furniture and equipment are of a high standard and well maintained. There is a selection of communal areas both inside and outside of the home, this means that service users have a choice to sit quietly, meet with family or be actively engaged with other service users. The lounge is spacious and has a conservatory attached and there is also kitchen/diner, all of these areas are homely and furnished to high standard. The garden is well maintained and service users are encouraged to participate in planting and watering the plants. There are different areas in which to sit and there are plans for a summer house to be erected this year. The bathrooms are homely and include the equipment to meet the needs of the service users. An electric chair has been installed which allows easy access to the bath and the service is looking at the possibility of an extra wide bath. There are sufficient toilets to enable immediate access. The kitchen and laundry are designed to enable and or maintaining their Independence. Where necessary risk assessments are in place to ensure the health and safety of the service users using the kitchen and laundry. Access is only limited where the risk assessment indicates such a need. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are recruited, trained and skilled to ensure that the service users receive the right support and that the home runs smoothly. Evidence: The service has a highly developed and robust recruitment procedure that has the needs of the service users at its core. The recruitment of good quality support workers are seen as integral to the delivery of an excellent service. The service is very selective with the recruitment of the right person for the job being more important than filling the vacancy. It is important that a prospective member of staff is able to demonstrate an ability to commit and adapt to the changing needs of the service users. Service users are involved in the interviews at Hulse Avenue. The manager demonstrated a proactive approach and a very good understanding of equality and diversity issues throughout the recruitment, induction and training process. The service has made a strong commitment to staff training that is focused on delivering improved outcomes for the service suers. Outlook Care has a very comprehensive training programme that begins with an in depth induction progamme. The service users external as well as internal trainers to deliver staff training. There are updates on mandatory training as well specialist training such as dementia, choking and resuscitation and behaviour that challenges. All of the staff have NVQ2/3 Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: other than newly recruited who are working toward their NVQ 2 and the majority of the staff have the LDQ (Learning Disability Qualification). Staff surveys all commented on the training that they receive and staff that we spoke to during the inspection confirmed that they had received appropriate training and one member of staff stated, The training is very good and what we learn helps us to improve the service. All staff receive regular supervision and yearly appraisals with the appropriate records being maintained. Staff meetings are used for information, consultation and training. Staff are encouraged to share their views of how the service should develop. Prior to the inspection we received a number of staff surveys and during the inspection we spoke to staff and were able to observe them interacting with the service users. Staff comments were Hulse Avenue is a very nice place to work, the manager is very supportive, Outlook Care are excellent at training programmes, we work as a team and support each other. A relative stated the staff team are brilliant, this is the best home they have lived in. It is very evident that the staff work as team and are committed to continue to provide an excellent service to the service users at Hulse Avenue. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management ensures that the home is run in the best interests of the service users, which is achieved by effective quality assurance systems and the promotion of high quality care. Evidence: The registered manager has the required qualifications and experience and is highly competent to run the home. It was evident during the inspection process that Hulse Avenue is being well managed and is meeting the organisations stated aims and objectives. The manager is very well supported by a deputy manager who has all of the relevant qualifications and experience and in the managers words we make a good team. The manager has a sound knowledge of the organisations strategic and financial planning systems and how the plan for the home fits into these. The manager works effectively and in collaboration with external agencies and the Commission. Staff that were spoken to during th inspection spoke positively about how well supported they felt by the manager. Through staff supervision, training and good management, service users are receiving a high standard of care and support. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: Person centred thinking, equality and diversity and human rights are given priority by the manager who was able to demonstrate a high level of understanding and best practice in these areas. As stated earlier we spoke to staff who told us that they felt supported and valued by the manager. relatives also spoke highly of the manager and were very confident in the service she and the staff were providing. The manager is totally focused on outcomes for service users and to this end, practice and performance are discussed during supervision and team meetings. Spot checks and quality monitoring provide evidence that practice reflects the homes policies and procedures. The AQAA (Annual Quality Assurance Assessment) contained excellent information that was fully supported by appropriate evidence.The home demonstrates a high level of self awareness and recognises the areas that it still needs to improve on and has clear ideas on how to implement these changes. The home has very efficient systems to ensure the effective safeguarding and management of service users valuables and money. Service users who do not have the skills to manage their own money are supported to become as independent as possible. We looked at other records and documentation including fire safety, health and safety checks, gas, electric, and found these to be up to date. The manager ensures that staff are trained in health and safety and safety matters, who share responsibilities for the regular safety checks of the home and report any discrepancies directly to the manager or deputy. The manager and staff have a good understanding of the risk assessment processes which is underpinned by promoting independence, choice and autonomy. Working practices within the home are safe and there are no preventable accidents. All of the homes accidents/incidents are reported to Outlook Care Board as a Key Performance indicator. Regualtion 26 visits as required under the Care Home Regulations 2001 are being undertaken. The manager and staff are up to date with current and new legislation and have undertaken training on the Mental Capacity Act 2005. Currently there have been no referrals under the Deprivation of Liberties Safeguards. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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